Feasibility, Acceptability, and Preliminary Efficacy of a Medication Intervention for Older Adults.

BackgroundExercise and nutrition are important for older adults to maintain or to regain their muscle mass, function, strength, and ultimately quality of life. The effectiveness of combined resistance exercise and diet interventions is commonly evaluated in controlled clinical studies, but evidence from real-life settings is lacking. This article describes the effectiveness, process, and economic evaluation design of a combined nutrition and exercise intervention for community-dwelling older adults in a Dutch real-life setting.MethodsThe ProMuscle in Practice study is a randomised controlled multicentre intervention study, conducted in five municipalities in the Netherlands. Two hundred community-dwelling older adults (≥65 years) who are frail or pre-frail based on Fried frailty criteria or who experience strength loss are randomised over an intervention and control group by municipality. In the first 12-week intensive support intervention, participants in the intervention group perform resistance exercise training guided by a physiotherapist twice a week and increase protein intake by consuming protein-rich products under the supervision of a dietitian. Afterwards, they continue with a 12-week moderate support intervention. The control group receives only regular care during the two 12-week periods. Effect outcomes are measured at all locations at baseline, 12 weeks, 24 weeks, 36 weeks and only at three locations at 52 weeks. The primary outcome is physical functioning (Short Physical Performance Battery). Secondary outcomes include leg muscle strength, lean body mass, activities of daily living, social participation, food intake, and quality of life. Qualitative and quantitative implementation process data are collected during the intervention. Healthcare use and intervention costs are registered for the economic evaluation.DiscussionEvaluating the effects, implementation, and costs of this combined intervention provides valuable insight into the feasibility of this intervention for community-dwelling older adults and into the intervention’s ability to improve or to maintain physical functioning and quality of life.Trial registrationNetherlands Trial Register (NTR6038) since 30 August 2016.

Smart Technology for Aging and Reducing Disability (STAReD): Study protocol for a randomized pragmatic clinical trial

Special Issue on Productive Aging: Evidence and Opportunities for Occupational Therapy Practitioners

Exercise is a highly recommended nonpharmacological intervention for older adults with sarcopenia. Poor exercise adherence is a main factor affecting treatment efficacy. However, evidence for overall adherence to exercise and intervention characteristics affecting adherence in this population remains unknown. To determine whether community-dwelling older adults with sarcopenia adhere to exercise programmes, what intervention components are used to improve adherence and how adherence relates to intervention characteristics and efficacy. Seven electronic databases and relevant systematic reviews were searched to identify randomised controlled trials (RCTs). The capability, opportunity, motivation and behaviour model with behaviour change techniques (BCTs) were used to categorise adherence intervention components. Random-effects meta-analysis and meta-regression analyses were employed. Seventeen RCTs with 2975 participants were included in this review. The pooled estimate of adherence rates for exercise interventions amongst older adults with sarcopenia was 85% (95% CI: 0.79-0.89, range: 71%-100%). Nine BCTs were identified from the included studies. Exercise with programme durations (<24weeks) (P = 0.01) might be associated with higher adherence rates compared with programme durations (≥24weeks). However, exercise adherence was not associated with intervention efficacy. Adherence to exercise interventions in community-dwelling older adults with sarcopenia is relatively high and may be affected by programme duration. Most studies incorporated only a small number of BCTs into their exercise interventions. Such an approach may be insufficient to enhance adherence in this population effectively. Future studies with theory-informed interventions to improve adherence in the field of exercise for older people with sarcopenia are needed.

Dynamic balance, an important contributor to fall risk in older adults, involves maintaining the center of pressure while in locomotive states and is. Fall risk appraisal (FRA) is defined as assessing an older adult's awareness of their physiological and perceived fall risk. This longitudinal study aimed to evaluate how multimodal factors predict fluctuations in dynamic balance in community-dwelling low-income older adults, utilizing fear of falling (FoF), static balance, fall history, and moderate-to-vigorous physical activity (MVPA). The longitudinal study included 140 community-dwelling, low-income older adults, with 124 women and 16 men. FoF was assessed using the Short Falls Efficacy Scale International (Short FES-I) and static balance using BTracks Balance Test (BBT). Both were utilized to define FRA Distance, an integrated quantification of physiological and perceived balance deficits. MVPA was assessed using accelerometers, fall history using self-report, and dynamic balance using the Timed Up and Go (TUG) test. The study was conducted at 4 timepoints at T1 (baseline), T2 (2 months), T3 (4 months), and T4 (6 months). Using mixed effects multilevel models, TUG scores were predicted by time, %MVPA, and FRA distance ratio. The effect of FRA distance ratio was primarily driven by FoF, and the effect of %MVPA varied by age. Additionally, while fall history did not show a predictive relationship with TUG scores, it did predict FRA distance. Dynamic balance fluctuated over time and was influenced by multimodal factors, namely MVPA and FRA, which captured the interplay between static balance and FoF. Fall history did not directly predict dynamic balance but played a role in FRA, implicating the subjective effects of fall history. These findings demonstrate how physical activity, FRA, and their interactions can predict changes in dynamic balance. Future work can utilize the results to evaluate low-cost interventions for community-dwelling older adults.

To appraise the external validity of physical activity interventions designed to reduce falls among community-dwelling older adults, using the reach, efficacy/effectiveness, adoption, implementation, and maintenance framework. Falls are a globally common, important, and a preventable problem. The efficacy of physical activity interventions to reduce falls among older adults is well established. Translation of this research into practice is slow as evidenced by persistently low proportions of older adults who engage in physical activities and the rising incidence of falls. Four electronic databases were searched for relevant studies published between 2000-2010. Studies that examined the effects of physical activity interventions designed to reduce falls among community-dwelling older adults were included in this review (n = 46). This was a quantitative systematic review with narrative synthesis. The reach, efficacy/effectiveness, adoption, implementation, and maintenance framework guided the identification, appraisal, and synthesis of indicators representing study validity. The majority of studies in this review described indicators representing internal validity. Details about indicators representing external validity were reported infrequently, limiting the generalizability of fall-preventive physical activity interventions in diverse cultures and social contexts over time. To foster translational research in real world settings, additional programmatic intervention research is needed that: (i) targets diverse populations; (ii) incorporates theories of behavioural change; (iii) describes and operationalizes critical content that enables replication and translation; (iv) tests innovative measures of fall risk and physical activity; and (v) evaluates feasibility and acceptability.

Context: Many older adults fail to meet dietary recommendations for food quality and quantity, which is important to prevent disability and disease. Group and community-based nutrition interventions may help overcome psychosocial, environmental, and behavioural barriers to healthy eating. The EMBOLDEN project uses community co-design, integrating the best available evidence with local knowledge to develop a novel, group-based physical activity, system navigation, and nutrition intervention for older adults. This review synthesizes evidence on nutrition interventions to inform design decisions. Objective: To identify the effectiveness of group-based interventions to promote healthy eating among older adults, to inform the co-design of a targeted, community-based intervention. Study Design: Systematic review. Setting or Dataset: MEDLINE, CINAHL, EMBASE, PsycINFO, and Sociological Abstracts were searched for studies published in English from January 2010 to June 2020. Interventions delivered to groups in community-based settings were eligible; acute and long-term care settings were excluded. Population studied: Healthy, community-dwelling older adults age 55+. Studies were excluded if they targeted specific disease populations. Intervention: Group-based nutrition interventions (alone or in combination), including food access, didactic and/or interactive nutrition education, and education with embedded behaviour change techniques (e.g., goal setting). Weight loss interventions were excluded. Outcome Measures: Primary outcomes were dietary intake, nutritional risk, knowledge, and dietary habits. Results: Thirty-one studies involving 6,723 older adults were included. Studies had generally unclear or high risk of bias. Given heterogeneity across interventions and outcomes, meta-analysis was not possible. Interactive nutrition education may improve dietary intake and knowledge, yet behaviour change strategies likely result in a greater reduction in nutritional risk. Results were shared with EMBOLDEN's Guiding Council of older adults and local health/social service providers to co-design the intervention. Conclusions: Although group-based interventions demonstrate promise in promoting healthier eating among community-dwelling older adults, the available evidence is relatively low quality. Our analysis highlights an opportunity for primary care researchers to advance the science of health promotion and disease prevention nutrition initiatives for older adults.

Feasible physical activity (PA) interventions to promote multicomponent PA among community-dwelling older adults in China are limited. We aimed to develop and test the implementation feasibility of a multicomponent PA intervention for community-dwelling older adults. The intervention was developed by a multidisciplinary working group based on behavior change theories and techniques. A 12-week feasibility study was conducted in a community in Hangzhou, China. Feasibility was tested by Bowen’s framework for assessing acceptability, demand, implementation, practicality, adaptation, integration, expansion, and limited efficacy of the PA intervention program. The PA intervention combined face-to-face group exercise (twice a week) in a community center and home-based exercise assisted by a WeChat applet or exercise manuals (at least once a week) with a weekly goal of engaging in multicomponent exercise at least three days per week. Overall, 19 participants (95%) completed the intervention (mean age of 77 years) with 12 participants using the applet and seven using the exercise manuals for home-based exercises. The intervention satisfied all Bowen’s feasibility criteria. In the third month, 93% of the applet users and 79% of the non-applet users adhered to weekly exercise goals. Significant improvements were observed in grip strength (+1.4 kg, 95% CI 0.1 to 2.7) and chair stand test (-3.5 seconds, 95% CI -4.9 to -2.2). The findings suggested that the PA intervention program was feasible in real-world settings, demonstrating its potential for promoting multicomponent PA among community-dwelling older adults. A large-scale randomized controlled trial is needed to test the long-term effectiveness.

Feasible physical activity (PA) interventions to promote multicomponent PA among community-dwelling older adults in China are limited. We aimed to develop and test the implementation feasibility of a multicomponent PA intervention for community-dwelling older adults. The intervention was developed by a multidisciplinary working group based on behavior change theories and techniques. A 12-week feasibility study was conducted in a community in Hangzhou, China. Feasibility was tested by Bowen’s framework for assessing acceptability, demand, implementation, practicality, adaptation, integration, expansion, and limited efficacy of the PA intervention program. The PA intervention combined face-to-face group exercise (twice a week) in a community center and home-based exercise assisted by a WeChat applet or exercise manuals (at least once a week) with a weekly goal of engaging in multicomponent exercise at least three days per week. Overall, 19 participants (95%) completed the intervention (mean age of 77 years) with 12 participants using the applet and seven using the exercise manuals for home-based exercises. The intervention satisfied all Bowen’s feasibility criteria. In the third month, 93% of the applet users and 79% of the non-applet users adhered to weekly exercise goals. Significant improvements were observed in grip strength (+1.4 kg, 95% CI 0.1 to 2.7) and chair stand test (-3.5 seconds, 95% CI -4.9 to -2.2). The findings suggested that the PA intervention program was feasible in real-world settings, demonstrating its potential for promoting multicomponent PA among community-dwelling older adults. A large-scale randomized controlled trial is needed to test the long-term effectiveness.

Chapter 1 General introduction Chapter 2 Translation of a tailored nutrition and resistance exercise intervention for elderly people to a real-life setting: adaptation process and pilot study Chapter 3 Effect, process, and economic evaluation of a combined resistance exercise and diet intervention (ProMuscle in Practice) for community-dwelling older adults: design and methods of a randomised controlled trial Chapter 4 Effectiveness of a diet and resistance exercise intervention on muscle health in older adults: ProMuscle in Practice Chapter 5 Process evaluation of a combined lifestyle intervention for community-dwelling older adults: ProMuscle in Practice Chapter 6 Process evaluation of a randomised controlled trial of a diabetes prevention intervention in Dutch primary health care: the SLIMMER study Chapter 7 General discussion

Mental health literacy and its relationship with health-promoting behaviors of community-dwelling older adults: A latent profile analysis.

Lifestyle interventions, combining nutrition and exercise, are effective in improving the physical functioning of community-dwelling older adults and preventing healthcare risks due to loss in muscle mass. However, the potential of these types of interventions is not being fully exploited due to insufficient implementation. Having insight into the determinants that could hinder or facilitate the implementation of a combined lifestyle intervention could improve the development of matching implementation strategies and enhance the implementation of such lifestyle interventions. The aim of this study was to identify barriers and facilitators for the successful implementation of a combined lifestyle intervention for community-dwelling older adults. A scoping review was conducted. A literature search was conducted in four electronic databases, and references were checked for additional inclusion. Studies were screened if they met the inclusion criteria. Barriers and facilitators were extracted from the included studies. To validate the results of the literature search, healthcare professionals and community-dwelling older adults were interviewed. Barriers and facilitators were categorized by two researchers according to the constructs of the Consolidated Framework for Implementation Research (CFIR). The search identified 12,364 studies, and 23 were found eligible for inclusion in the review. Barriers and facilitators for 26 of the 39 constructs of the CFIR were extracted. The interviews with healthcare professionals and older adults yielded six extra barriers and facilitators for implementation, resulting in determinants for 32 of the 39 CFIR constructs. According to literature and healthcare professionals, cosmopolitanism (network with external organizations), patient needs and resources, readiness for implementation, costs, knowledge and beliefs about the intervention, network and communication, and engaging were found to be the most important determinants for implementation of a combined lifestyle intervention. A broad range of barriers and facilitators across all domains of the CFIR framework emerged in this study. The results of this review reflect on determinants that should be taken into account when planning for the implementation of a combined lifestyle intervention. A further step in the implementation process is the development of implementation strategies aiming at the identified determinants to enhance the implementation of a combined lifestyle intervention in community care.

Feasibility of a Multicomponent Digital Fall Prevention Exercise Intervention for At-Risk Older Adults.

As life expectancy rises at a faster rate than healthy life expectancy, there is a global need for scalable and cost-effective interventions that enhance the health-related quality of life of older adults. This study aimed to examine the user experience and usability of a 12-week digital multidomain lifestyle intervention in community-dwelling older adults aged 65years and above. The intervention was developed involving older adults and delivered through a mobile application (app) focusing on physical activity, nutrition, sleep and mindfulness/relaxation. We used a mixed methods sequential explanatory approach to evaluate the user experience and usability of the intervention. We delivered online questionnaires before and after the intervention, collected app usage data and conducted semi-structured interviews. One hundred eight older adults participated in the study. Fifty-six percent of participants completed the 12-week intervention. Users who completed the intervention experienced it as highly satisfactory and rated the usability as high. User engagement was particularly high for the physical activity content. Although participant retention can be a challenge, a digital multidomain lifestyle intervention developed involving community-dwelling older adults can lead to positive user experience and high usability.

BackgroundThis study examines the feasibility, acceptability, and safety of a newly developed cognitive-enhancing Tai Ji Quan training intervention, delivered via remote videoconferencing, for older adults with mild cognitive impairment (MCI).MethodsIn a three-arm feasibility trial, community-dwelling older adults with MCI (N = 69; mean age = 74.6 years, 57% women) were randomized to a cognitively enhanced Tai Ji Quan (n = 23), standard Tai Ji Quan (n = 22), or stretching group (n = 24) and participated in a 60-minute online exercise session via Zoom, twice weekly for 16 weeks. Participants were recruited primarily in the state of Oregon through mass mailing and word of mouth. The primary outcomes were intervention feasibility (with respect to recruitment, online intervention delivery, fidelity and compliance, and attrition and retention rates), acceptability, and safety. We also assessed feasibility of online data collection and test-retest reliability and explored preliminary trends on secondary outcomes that included global cognitive function, dual-task cost, and domain-specific cognition function.ResultsThe study had an average recruitment rate of 55%. Feasibility was demonstrated by the overall successful online program implementation, with good fidelity, acceptable compliance (76%), and excellent retention (94%). The cognitively enhanced Tai Ji Quan intervention was shown to be acceptable to participants as well as safe, with no major intervention-related moderate/severe events. At week 16, the group receiving cognitively enhanced Tai Ji Quan training showed a positive trend in the cognitive function and dual-task outcome measures whereas the group receiving standard Tai Ji Quan training exhibited positive trends on global and domain-specific cognitive measures.ConclusionsPreliminary findings of this pilot study indicate the feasibility, acceptability, and safety of a tailored, cognitively enhanced Tai Ji Quan training intervention delivered remotely to home settings via videoconferencing for community-dwelling older adults with MCI.Trial registrationClinicaltrials.gov identifier NCT04070703